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Acta médica peruana, May 9, 2022
Peruvian Journal of Neurosurgery
Introduction: Calcified thoracic disc herniations are rare and their approach represents a surgic... more Introduction: Calcified thoracic disc herniations are rare and their approach represents a surgical challenge when they are giant and symptomatic Surgery is indicated in cases of intractable back pain with medical management persistent intercostal neuralgia or progressive neurological deficit with the transthoracic extrapleural approach being the one of choice because it has advantages regarding the best view of the operative field We present the case of a patient with a giant calcified thoracic hernia who was successfully operated on in our hospital using an extrapleural transthoracic approach. Clinical case: A 53-year-old male with dorsal pain in the medial region radiating to the inframammary region and progressive difficulty walking moderate proximal paraparesis T8 sensory level and urinary retention CT and MRI images showed a large calcified T6-7 disc herniation causing severe compression of the spinal cord The patient underwent a T6-7 extrapleural transthoracic discectomy plus...
Peruvian Journal of Neurosurgery
Introduction: Spinal tuberculosis TB represents 1% of all TB cases and 50 - 60 of osteoarticular ... more Introduction: Spinal tuberculosis TB represents 1% of all TB cases and 50 - 60 of osteoarticular TB cases.1 Certain atypical clinical and radiological presentations of spinal tuberculosis are described infrequently. 2 The lack of recognition of these presentations can lead to a delay in diagnosis and the initiation of treatment. 3 We present the case of a patient with atypical vertebral tuberculosis operated on in our hospital. Clinical case: A 56-year-old male with a history of diabetes mellitus and no history of tuberculosis contact with a 3-year history of moderate low back pain without sciatic pain that did not improve with physical therapy. The general and systemic physical examination was normal. The tests showed PCR 9.8 ESR 24 BK in the sputum brucellosis test, and ELISA and chest X-ray were normal. A tomography and magnetic resonance imaging of the lumbosacral spine showed an osteolytic lesion involving L2 L3, isointense on T1, with regular punched-out borders sparing the L2...
Peruvian Journal of Neurosurgery
Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the deg... more Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the degenerative changes that it can present. Contrast-enhanced magnetic resonance helps us diagnose, as it can show heterogeneous lesions that capture ring contrast. The treatment is surgical. Clinical Case: A 67-year-old male patient is presented, with 2 years of the disease characterized by thoracic radicular pain and severe paraparesis in the last 6 months. Contrast-enhanced MRI showed a tumor with heterogeneous uptake, widening the right T2/T3 foramina with right anterior paravertebral extension and severe canal stenosis at the T2 level. A laminectomy plus total resection of the lesion was performed; the pathology study was reported as ancient schwannoma. The evolution was favorable, with complete recovery of muscle strength in subsequent months. Conclusion: Ancient schwannoma is a rare pathology that has peculiar imaging characteristics and whose treatment is surgical. Keywords: Schwannom...
Peruvian Journal of Neurosurgery
Objective: Herniation of the nucleus pulposus (HNP) is the leading cause of sciatica. The standar... more Objective: Herniation of the nucleus pulposus (HNP) is the leading cause of sciatica. The standard diagnostic test is magnetic resonance imaging, and treatment can be conservative or surgical. The most common surgical technique is lumbar microdiscectomy. The objective of the study was to know the epidemiological and clinical profile, as well as the surgical results of patients undergoing lumbar microdiscectomy at the Almenara Hospital from January 2018 to August 2021. Methods: Descriptive, retrospective, and cross-sectional epidemiological study. We found 82 patients who underwent lumbar microdiscectomy with complete data in the clinical history. The data was collected from the clinical history of hospitalization and outpatient consultation. Proportions were applied for qualitative variables and mean with confidence interval in quantitative variables. Results: Of the total number of patients, 69.51% were male, the most frequent age group was 31-50 years, and most came from Lima. The...
Peruvian Journal of Neurosurgery
Introduction: Capillary hemangioma is an extremely rare endothelial cell neoplasm as an extramedu... more Introduction: Capillary hemangioma is an extremely rare endothelial cell neoplasm as an extramedullary intradural tumor. Its presentation in infants is anecdotal and only 2 cases have been previously reported in the literature. Clinical case: a 03-month-old infant with severe abrupt-onset paraparesis. Spinal magnetic resonance imaging (MRI) showed an intraspinal tumor at the T7, T8, and T9 levels, which captures contrast. A T7-T9 laminectomy and microsurgical resection of the extramedullary spinal tumor were performed. The pathology was reported as lobulated angiomatous proliferation with focal vascular thrombus, with positive immunohistochemistry for CD 31 and 34, compatible with capillary hemangioma. The neurological evolution was favorable. Post-surgical MRI and spinal angiography showed little residual tumor and hydrosyringomyelia in remission. Conclusion: Capillary hemangioma is a rare pathology in infants, this case being the 3rd case reported. Its diagnosis and surgical resec...
Surgical Neurology International, 2021
Antecedentes:El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frec... more Antecedentes:El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión.Métodos:Los autores revisaron la fisiopatología y características clínicas del HSDC. El presente artículo discute acerca de las terapéuticas actuales y las nuevas opciones de tratamiento que podrían mejorar los resultados. Este manuscrito es susceptible de cambios en el tiempo, con el desarrollo científico y tecnológico.Resultados:El HSDC puede ser abordado por vía quirúrgica y farmacológica; no obstante, un manejo individua...
Acta médica peruana, May 8, 2023
Horizonte Médico (Lima)
Presentamos un caso de un neumomediastino espontáneo, efecto Macklin, en un hombre de 49 años con... more Presentamos un caso de un neumomediastino espontáneo, efecto Macklin, en un hombre de 49 años con comorbilidades y diagnóstico de COVID-19. El paciente recibió soporte vital total pero evolucionó de manera desfavorable y con inestabilidad hemodinámica, la cual progresa a un choque obstructivo por el neumomediastino. Aunque es un cuadro inusual, es importante conocer la clínica, el diagnóstico y el manejo de esta entidad en las unidades de cuidados intensivos.
REVISTA ARGENTINA DE NEUROCIRUGIA, 2021
Hematoma subdural crónico: una patología común de manejo complejo RESUMEN El hematoma subdural cr... more Hematoma subdural crónico: una patología común de manejo complejo RESUMEN El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Entender el mecanismo de la enfermedad ha permitido explicar su historia natural y a su vez proponer nuevas alternativas de tratamiento. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión. A pesar de los avances en el campo de la neurocirugía, la clásica trepanación craneal sigue siendo el Gold estándar en el HSDC y sobre todo en pacientes con síntomas graves. Se debe resaltar que aún hay aspectos de este procedimi...
Acta médica peruana, May 9, 2022
Peruvian Journal of Neurosurgery
Introduction: Calcified thoracic disc herniations are rare and their approach represents a surgic... more Introduction: Calcified thoracic disc herniations are rare and their approach represents a surgical challenge when they are giant and symptomatic Surgery is indicated in cases of intractable back pain with medical management persistent intercostal neuralgia or progressive neurological deficit with the transthoracic extrapleural approach being the one of choice because it has advantages regarding the best view of the operative field We present the case of a patient with a giant calcified thoracic hernia who was successfully operated on in our hospital using an extrapleural transthoracic approach. Clinical case: A 53-year-old male with dorsal pain in the medial region radiating to the inframammary region and progressive difficulty walking moderate proximal paraparesis T8 sensory level and urinary retention CT and MRI images showed a large calcified T6-7 disc herniation causing severe compression of the spinal cord The patient underwent a T6-7 extrapleural transthoracic discectomy plus...
Peruvian Journal of Neurosurgery
Introduction: Spinal tuberculosis TB represents 1% of all TB cases and 50 - 60 of osteoarticular ... more Introduction: Spinal tuberculosis TB represents 1% of all TB cases and 50 - 60 of osteoarticular TB cases.1 Certain atypical clinical and radiological presentations of spinal tuberculosis are described infrequently. 2 The lack of recognition of these presentations can lead to a delay in diagnosis and the initiation of treatment. 3 We present the case of a patient with atypical vertebral tuberculosis operated on in our hospital. Clinical case: A 56-year-old male with a history of diabetes mellitus and no history of tuberculosis contact with a 3-year history of moderate low back pain without sciatic pain that did not improve with physical therapy. The general and systemic physical examination was normal. The tests showed PCR 9.8 ESR 24 BK in the sputum brucellosis test, and ELISA and chest X-ray were normal. A tomography and magnetic resonance imaging of the lumbosacral spine showed an osteolytic lesion involving L2 L3, isointense on T1, with regular punched-out borders sparing the L2...
Peruvian Journal of Neurosurgery
Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the deg... more Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the degenerative changes that it can present. Contrast-enhanced magnetic resonance helps us diagnose, as it can show heterogeneous lesions that capture ring contrast. The treatment is surgical. Clinical Case: A 67-year-old male patient is presented, with 2 years of the disease characterized by thoracic radicular pain and severe paraparesis in the last 6 months. Contrast-enhanced MRI showed a tumor with heterogeneous uptake, widening the right T2/T3 foramina with right anterior paravertebral extension and severe canal stenosis at the T2 level. A laminectomy plus total resection of the lesion was performed; the pathology study was reported as ancient schwannoma. The evolution was favorable, with complete recovery of muscle strength in subsequent months. Conclusion: Ancient schwannoma is a rare pathology that has peculiar imaging characteristics and whose treatment is surgical. Keywords: Schwannom...
Peruvian Journal of Neurosurgery
Objective: Herniation of the nucleus pulposus (HNP) is the leading cause of sciatica. The standar... more Objective: Herniation of the nucleus pulposus (HNP) is the leading cause of sciatica. The standard diagnostic test is magnetic resonance imaging, and treatment can be conservative or surgical. The most common surgical technique is lumbar microdiscectomy. The objective of the study was to know the epidemiological and clinical profile, as well as the surgical results of patients undergoing lumbar microdiscectomy at the Almenara Hospital from January 2018 to August 2021. Methods: Descriptive, retrospective, and cross-sectional epidemiological study. We found 82 patients who underwent lumbar microdiscectomy with complete data in the clinical history. The data was collected from the clinical history of hospitalization and outpatient consultation. Proportions were applied for qualitative variables and mean with confidence interval in quantitative variables. Results: Of the total number of patients, 69.51% were male, the most frequent age group was 31-50 years, and most came from Lima. The...
Peruvian Journal of Neurosurgery
Introduction: Capillary hemangioma is an extremely rare endothelial cell neoplasm as an extramedu... more Introduction: Capillary hemangioma is an extremely rare endothelial cell neoplasm as an extramedullary intradural tumor. Its presentation in infants is anecdotal and only 2 cases have been previously reported in the literature. Clinical case: a 03-month-old infant with severe abrupt-onset paraparesis. Spinal magnetic resonance imaging (MRI) showed an intraspinal tumor at the T7, T8, and T9 levels, which captures contrast. A T7-T9 laminectomy and microsurgical resection of the extramedullary spinal tumor were performed. The pathology was reported as lobulated angiomatous proliferation with focal vascular thrombus, with positive immunohistochemistry for CD 31 and 34, compatible with capillary hemangioma. The neurological evolution was favorable. Post-surgical MRI and spinal angiography showed little residual tumor and hydrosyringomyelia in remission. Conclusion: Capillary hemangioma is a rare pathology in infants, this case being the 3rd case reported. Its diagnosis and surgical resec...
Surgical Neurology International, 2021
Antecedentes:El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frec... more Antecedentes:El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión.Métodos:Los autores revisaron la fisiopatología y características clínicas del HSDC. El presente artículo discute acerca de las terapéuticas actuales y las nuevas opciones de tratamiento que podrían mejorar los resultados. Este manuscrito es susceptible de cambios en el tiempo, con el desarrollo científico y tecnológico.Resultados:El HSDC puede ser abordado por vía quirúrgica y farmacológica; no obstante, un manejo individua...
Acta médica peruana, May 8, 2023
Horizonte Médico (Lima)
Presentamos un caso de un neumomediastino espontáneo, efecto Macklin, en un hombre de 49 años con... more Presentamos un caso de un neumomediastino espontáneo, efecto Macklin, en un hombre de 49 años con comorbilidades y diagnóstico de COVID-19. El paciente recibió soporte vital total pero evolucionó de manera desfavorable y con inestabilidad hemodinámica, la cual progresa a un choque obstructivo por el neumomediastino. Aunque es un cuadro inusual, es importante conocer la clínica, el diagnóstico y el manejo de esta entidad en las unidades de cuidados intensivos.
REVISTA ARGENTINA DE NEUROCIRUGIA, 2021
Hematoma subdural crónico: una patología común de manejo complejo RESUMEN El hematoma subdural cr... more Hematoma subdural crónico: una patología común de manejo complejo RESUMEN El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Entender el mecanismo de la enfermedad ha permitido explicar su historia natural y a su vez proponer nuevas alternativas de tratamiento. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión. A pesar de los avances en el campo de la neurocirugía, la clásica trepanación craneal sigue siendo el Gold estándar en el HSDC y sobre todo en pacientes con síntomas graves. Se debe resaltar que aún hay aspectos de este procedimi...